Monthly Archives: September 2009

This afternoon, I attended a town hall meeting that was organized by Senator Evan Bayh’s office. The Senator himself was not there, but in his stead was acting Regional Director, Sandi Stewart. Though I spoke at the meeting, comments were limited to only a couple minutes, so I sent the following email to Ms Stewart to follow-up on my remarks.

Ms Stewart,

I wanted to thank you again for holding today’s town hall meeting and for taking comments from those of us in Bloomington who are very much in favor of a public health insurance plan.

I would like to reiterate, and perhaps expand upon, the remarks I made this afternoon. I spoke about my desire to see Sen Bayh take the lead on two issues that I consider essential to a successful health reform bill — an emphasis on prevention; and an emphasis on biomedical research.

The Senator is, I believe, ideally placed to lead on these issues. He is known (some might say notorious) for being a conservative Democrat, and therefore he is concerned about the costs involved in any plan for healthcare reform. It has been demonstrated time and again that informed preventive practices can reduce the cost of health care — in the very obvious sense that it may flat-out keep certain conditions from occurring; but also in that early detection and treatment affords the opportunity to address a medical condition before it becomes so advanced as to require extraordinary means.

If the Senator is concerned about the cost of health care, he will push for a system that emphasizes preventive care — fully covering annual physical examinations; covering regular screenings for conditions which patients are specifically at risk of developing; providing comprehensive support, guidance, and medical attention for expecting mothers (especially first-time mothers), so they may decide, with confidence, to bring their child into the world; and an ongoing list of actions that can keep people healthy, instead of merely waiting for them to become ill.

The best way for these preventive practices to be established is, I believe, through a universally available public health insurance plan that sets, for the rest of the health insurance industry, a basic standard of best practices.

The second issue, biomedical research, is related. The deeper our understanding of conditions, the greater our ability to preempt their development or, barring that, treat the condition at its root instead of ameliorating symptoms. My thinking on this has for years been guided by the writing of the late Lewis Thomas — specifically, his essay “The Technology of Medicine”, which is included in the volume THE LIVES OF A CELL (Penguin, 1973). In summary, Thomas breaks medical technology into three types —

1.) the “non”-technology, which includes hospice care, pain management, and other actions which do not aim to affect the outcome of a disease or condition, but instead “waits it out”

2.) the “halfway” technology, in which category he includes organ replacements, chemotherapy, iron lungs (now long obsolete, thankfully), and other methods of treatment that, lacking a fundamental understanding of a condition, aim to address how the condition manifests itself; these are inevitably more expensive and, though sophisticated in appearance, are rather quite primitive

3.) the “real” technology, such as vaccines and antibiotics, which treat a condition’s cause instead of its symptoms; this technology can only come as a result of knowing the inner mechanism of a condition — a knowledge that itself only comes from constant, vigilant, innovative research

The Senator is already an advocate of this issue through his involvement with the Senate Medical Technology Caucus and, outside of the Senate, the Medical Technology Leadership Forum, now based in Indianapolis. He is in a perfect place to emphasize the need to continue, and even expand, federal research spending with the long-term goal of developing treatment technologies which ultimately lower health care costs.

And, finally, with both prevention and research in mind, I hope Sen Bayh will lead a shift in the debate that will move us away from the language of cost and towards a language of investment. Whatever the government spends on health care is not simply an expense, but an investment in the health and welfare of our citizenry. It must be acknowledged, and repeated over and over, that only a healthy citizenry can effectively educate and defend itself, and compete in the global market.

Thank you, again, for listening to me and my fellow voters this afternoon. I hope our comments and concerns will be welcomed and taken to heart by the Senator.